Abstract [en]

Healthy dietary changes would be beneficial for society, as the economic burden of diet-related diseases is massive, and for the individual, who would reduce their risk of ill health. However, it is not easy to change dietary habits. Therefore, the aim of this thesis was to better understand dietary change, focusing on the barriers to and facilitators of healthy dietary change by i) examining changes in food choices when dietary change is imposed by a medical diagnosis, ii) examining experiences related to dietary change and its sustainability after participation in a study where healthy dietary changes were required, and iii) examining diet cost in relation to healthiness of the diet.

Methods Eighty children aged 13 who were diagnosed with celiac disease (CD) by a screening study reported their food intake in a food frequency questionnaire before and 1,5 years after commencing a gluten-free diet. Changes in food intake and the healthiness of the diet were examined, controlling for societal changes through the use of an age- and sex-matched control group. Diet healthiness was assessed using the National Food Administration’s (NFA) food index and the Diet Quality Index-Swedish Nutritional Recommendations. Qualitative interviews were conducted with 14 individuals who participated in an intervention study five years earlier where they had been randomly selected to adhere to a Mediterranean-like diet for three months. Analyses of the transcribed interviews focused on their experiences of barriers to and facilitators of dietary change and its sustainability. The costs related to healthy diets were examined by comparing consumer food prices with dietary intake data collected in two separate studies. The first study collected dietary intake data through a diet history interview with participants who had been randomized to either a Mediterranean-like diet or to continue their normal diet. The second study collected dietary intake data from 4-, 8-, and 11-year-old children by means of food diaries and was conducted by the NFA. Diet healthiness was assessed using the Healthy Eating Index 2005.

Results The screened CD group made relatively few changes to their diets. They decreased their intake of certain gluten-containing products, including pizza, chicken nuggets, fish sticks, and pastries. There were no changes in the healthiness of their diet. The narratives of the individuals changing their diets showed that social relationships were the main barrier to sustainability. Social relationships within the household were especially troublesome, and various coping strategies were required on an everyday basis. Dietary change also increased the burden of food work (e.g., planning, shopping, cooking), which was another major barrier to dietary change. Comparisons between consumer costs of healthy and less healthy diets showed that those consuming the healthier diets also had consumed more expensive diets.

Conclusion More barriers to healthy dietary changes were found than facilitators of these transitions. For instance, the impact of social relationships on sustainability of dietary change was found to be high, indicating the importance of participation of other household members when dietary changes are implemented. The higher cost of the healthier diets may be another barrier for healthy dietary changes, especially for those with limited resources. Even though it is possible to eat healthily at a lower cost, such a diet would likely require both cooking skills and time, thus making the task more difficult. However, the finding that children diagnosed with CD only made minor changes in their consumption of, for instance, bread and pasta, indicates that one way of increasing the healthiness of a diet is to substitute healthier alternatives within the same food group for less healthy food items.

Rydén, Petra

Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.

Kautto, Ethel

Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.

Ivarsson, Anneli

Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.

Olsson, Cecilia

Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.

Norström, Fredrik

Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.

Högberg, L

Department of Clinical and Molecular Medicine, Linköping University.

Carlsson, A

Department of Pediatrics, Lund University.

Hagfors, Linda

Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.

Hörnell, Agneta

Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.

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(English)Manuscript (preprint) (Other academic)

Abstract [en]

Objectives To explore how diagnosis of celiac disease (CD) in early adolescence affects overall food intake and healthiness of the diet in comparison with age- and sex matched controls and children with CD diagnosed in early childhood.

Methods This is a longitudinal dietary sub-study of a school-based CD-screening of 12-year-olds (ETICS - Exploring the Iceberg of Coeliacs in Sweden), a part of the PreventCD project. The dietary study was conducted in 2005-2008 and included the following groups resulting from the screening: I) screening-detected CD cases (n=80), II) previously diagnosed CD cases (n=28), and III) two samples of age- and sex matched non-CD children (admission, n=619; follow-up, n=447). All CD cases completed two food-frequency-and-amount-questionnaires (FFQ), covering the previous four weeks; one at admission and one at a follow-up 18-24 months later. The screening-detected CD cases completed the first FFQ before a gluten free diet was initiated. The non-CD children consisted of a cross-sectional sample at each time point, and thus only completed one FFQ each (i.e. either at admission or follow-up). The Goldberg cut-off method was used to validate reported energy intake. The food choices at admission and follow-up were compared among the three groups, and the healthiness of the diet evaluated using two Swedish dietary indexes.

Results and Conclusion Intakes of most food groups were similar at baseline. The adolescents diagnosed with CD did only minor changes in their overall food choices. Visible changes were reductions within food groups where gluten-free alternatives are not readily available, such as pastries and pizza. In contrast, total intake of bread and pasta did not change. All three groups scored fairly low on the dietary indexes at both time points, and there is an obvious need to improve the healthiness of the adolescent diet, whether CD is present or not.

National Category

Food Science Gastroenterology and Hepatology Pediatrics Other Social Sciences not elsewhere specified

Abstract [en]

Background: Changing to healthier dietary habits is quite difficult to implement and even more difficult to sustain. As the majority of people have some or all their meals with others, it is likely that their social relationships influence the dietary change process and its sustainability. Thus, the aim of this research was to explore and describe experiences of dietary change and its sustainability in the context of an individual’s social relationships.Methods: Semi-structured interviews were conducted individually with fourteen individuals who had previously been participants in a 3-month dietary intervention study using a Mediterranean diet. Thematic analysis was used on verbatim transcripts of the interviews. Results: Social relationships were the main barrier to sustainability – in particular social relationships within the household where various coping strategies were needed on an everyday basis. Social relationships outside the household were also difficult to manage as dietary change challenged existing traditions and norms of what to eat. The changer was thereby forced to risk social disapprova lor to deviate from the diet. Conclusions: Social relationships within and outside the household complicated the accomplishment of healthy dietary changes. Hence, it is important to acknowledge the social context of the changer when dietary change is to be implemented.

Abstract [en]

The aim of this research was to examine the cost of a diet generally regarded as healthy, a Swedish version of the Mediterranean diet, and to compare it with the cost of an ordinary Swedish diet. A total of 30 individuals provided detailed dietary data collected in a randomized intervention study, examining the effect of dietary change to a Mediterranean-style diet in patients with rheumatoid arthritis (Mediterranean group, n = 16, control group, n = 14). The data, covering 1-month dietary intake, were examined with three different diet quality indicators to see whether the Mediterranean group consumed a healthier diet than the control group. All diet quality indicators showed that the Mediterranean group consumed a healthier diet than the control group. Consumer food prices were used to analyse the cost of the different diets. In immediate consumer cost terms, eating a healthier diet was more expensive when differences in energy intake were discounted. However, non-energy adjusted costs showed no significant difference between the groups. Hence, if one of the reasons for choosing a healthier diet is to achieve weight loss – by consuming less energy – it is possible that healthier eating is not more expensive.

Abstract [en]

Objective: To examine diet costs in relation to dietary quality and socio-economic position, and to investigate underlying reasons for differences in diet costs.

Design: Dietary intake was assessed by a 4 d food diary and evaluated using the 2005 Healthy Eating Index (HEI). National consumer food prices collected by Statistics Sweden and from two online stores/supermarkets were used to estimate diet costs.

Setting: Sweden.

Subjects: A nationally representative sample of 2160 children aged 4, 8 or 11 years.

Results: Higher scores on the HEI resulted in higher diet costs and, conversely, higher diet costs were linked to increased total HEI scores. Children who consumed the most healthy and/or expensive diets ate a more energy-dilute and varied diet compared with those who ate the least healthy and/or least expensive diets. They also consumed more fish, ready meals and fruit. Regression analysis also linked increased food costs to these food groups. There was a positive, but weak, relationship between HEI score and diet cost, parental education and parental occupation respectively.

Conclusions: Healthy eating is associated with higher diet cost in Swedish children, in part because of price differences between healthy and less-healthy foods. The cheapest and most unhealthy diets were found among those children whose parents were the least educated and had manual, low-skill occupations. Our results pose several challenges for public health policy makers, as well as for nutrition professionals, when forming dietary strategies and providing advice for macro- and microlevels in society.